Santa Monica Water Polo Club (SMWPC)

IF PLAYER IS NOT CURRENTLY REGISTERED WITH USA WATER POLO, PLEASE RENEW OR REGISTER NOW!!

In addition to completing the registration form below, all SMWPC athletes must register with USA Water Polo as a member of Santa Monica Water Polo Club in order to practice or compete. Memberships are on a calendar year basis, and expire on December 31. New registrations or renewals made between November 1 and December 31 will be valid for the following calendar year. Registration must be completed online via the USA Water Polo website at www.usawaterpolo.org using a VISA or MasterCard.

AGE VERIFICATION

Once the USA Water Polo registration is completed, the age verification needs to be completed. Instructions are on the USA Water Polo website, at www.usawaterpolo.org

How did you find out about us?
*

Athlete's Name:
*

First Name Last Name

Address:
*

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Athlete's Cell Phone:

-
Area Code Phone Number

Athlete's Email:

Birth Date
*

Month Day Year

Age:
*

Parent/Guardian #1: (Athlete's info if Athlete is over 18 years old)
*

First Name Last Name

Parent Cell Phone: (Athlete's info if Athlete is over 18 years old)
*

-
Area Code Phone Number

Parent Home Phone: (Athlete's info if Athlete is over 18 years old)
*

-
Area Code Phone Number

Parent E-mail: (Athlete's info if Athlete is over 18 years old)
*

Parent/Guardian #2:

First Name Last Name

Parent Cell Phone:

-
Area Code Phone Number

Parent Home Phone:

-
Area Code Phone Number

Parent E-mail:

USA Water Polo #:
*

Go to www.USAWaterPolo.com to register if you dont have a USAWaterPolo membership number

USA Water Polo Membership Expiration Date:
*

-
Month
-
Day Year

PARTICIPATION AND RELEASE

Media Authorization:

Code of Conduct:

Parent Code of Conduct:

We Read and Agree to All Terms and Disclaimers (Both boxes need to be checked off)
*

Athlete's Acknowledgement Parent's or Legal Guardian's Acknowledgement (Athlete's Acknowledgement if Athlete is over 18 years old)

I understand Santa Monica Water Polo club's membership dues are monthly charges and my credit card will be automatically charged each month
*

I agree

After clicking "submit" below, registration will be processed. First listed parent/athlete will receive a confirmation email and you will be redirected to our store where water polo team gear is available for purchase.

Monthly Membership Dues:
*

Splashball and Elementary School Water Polo ($100 for the first month, then $100 each month thereafter)
(
$
100.00
for each
month.)

Middle School Water Polo ($185 for the first month, then $185 each month thereafter)
(
$
185.00
for each
month.)

High School Water Polo ($185 for the first month, then $185 each month thereafter)
(
$
185.00
for each
month.)

Master's Water Polo ($45 for the first month, then $45 each month thereafter)
(
$
45.00
for each
month.)